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New postings and analysis from Health Affairs, the leading journal of health policy. Health Affairs publishes new research each week online at For more information, contact Chris Fleming at 301-347-3944.

Study: Nonprofit Impact And Grounds For Tax Exemption Go Beyond Free Care

By itself, the amount of indigent care provided by nonprofit hospitals and other nonprofit health care entities does not justify their tax exemptions, but these institutions often provide other, less easily measured benefits that vary from service to service and from community to community. "Thus, restricting the rationale for tax exemption to indigent care, as done in some states and favored by some policy analysts, is a misguided approach to improving community health," say Mark Schlesinger and Bradford Gray in the lead article of a four-paper package on nonprofits published June 20 on the Health Affairs Web site.

High-Deductible Plans Sprout, But Workers And Firms Respond Cautiously

Over the past few years, health plans of all types - even HMOs -- have focused product development on "consumer-directed" plans with high deductibles, often accompanied by tax-favored health spending accounts or health reimbursement arrangements. However, say researchers from the Center for Studying Health System Change in the May/June Health Affairs, employer response has been cautious: For example, only 12 employers in Little Rock, Arkansas, chose to offer consumer-directed plans in 2005. Large firms were supportive of these plans, but employee take-up rates for consumer-directed plans ranged from 2 to 35 percent and were typically under 15 percent.

Print editions of Health Affairs may be ordered for $35 each from Health Affairs' Customer Service at 301-347-3900 or online at

Mental Health Changes Empowered Consumers, Not Vice Versa, Says Author

"The growing influence of consumer/survivor perspectives has largely been a consequence, not a cause, of radical restructurings of the mental health field," Nancy Tomes reports in the May/June Health Affairs. Tomes says that "consumer perspectives entered policy discourse in the wake of policy failures"; for example, in the 1970s, a failure to fund and coordinate medical and social services for deinstitutionalized people with mental illness rendered self-help "a strategy that was critical to consumer survival." Consumer perspectives have continued to flourish "in a climate of perpetual crisis and tight budgets," Tomes adds.


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it switches to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.


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